Combined oral contraceptives & cerebral venous sinus thrombosis: 2 cases and review

Anshuja Singla, Garima Yadav, Sneha Shree

Abstract


The incidence of venous thromboembolism with combined oral contraceptive is 20-30 per 1 lakh women years. Studies have shown that there is an increasing risk of VTE in current users and risk decreases with both time of use and decreasing estrogen dose. We report two cases in which both women had CVST triggered by combined oral contraceptive use. Before prescribing COCs, a complete personal and family history along with evaluation of risk factors for VTE and cardiovascular diseases is mandatory to ensure safe use of COCs.

 


Keywords


Combined oral contraceptive, Venous thromboembolism, Eastrogen

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References


Fruzzetti F, Perini D, Spirito N, Manca R. Oral contraceptive pill and thrombotic risk: epidemiological studies. Minerva Ginecol. 2012;64:539-49.

Vandenbroucke JP, Helmerhorst FM, Bloemenkamp KW, Rosendaal FR. Third-generation oral contraceptive and deep venous thrombosis: from epidemiologic controversy to new insight in coagulation. Am J Obstet Gynecol. 1997;177:887-91.

Walker AM. Newer oral contraceptives and the risk of venous thromboembolism. Contraception. 1998;57:169-81.

Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ 2011;343:d6423.

WHO. Cardiovascular disease and steroid hormone contraception: report of a WHO scientific group. World Health Organ Tech Rep Ser. 1998;877:1-89.

de Bruijn SF, Stam J, Koopman MM, Vandenbroucke JP. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in (correction of who are) carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group. BMJ. 1998;316(7131):589-92.

Martinelli I, Sacchi E, Landi G, Taioli E, Duca F, Mannucci PM. High risk of cerebral-vein thrombosis in carriers of a prothrombin-gene mutation and in users of oral contraceptives. N Engl J Med. 1998;338(25):1793-7.

Jick SS, Jick H. Cerebral venous sinus thrombosis in users of four hormonal contraceptives: levonorgestrel-containing oral contraceptives, norgestimate-containing oral contraceptives, desogestrel-containing oral contraceptives and the contraceptive patch. Contraception. 2006;74(4):290-2.

Sitruk-Ware R, Plu-Bureau G, Menard J, Conard J, Kumar S, Thalabard JC, et al. Effects of oral and transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, crossover study. J Clin Endocrinol Metab. 2007;92(6):2074-9.

Rad M, Kluft C, Ménard J, Burggraaf J, de Kam ML, Meijer P, et al. Comparative effects of a contraceptive vaginal ring delivering a nonandrogenic progestin and continuous ethinyl estradiol and a combined oral contraceptive containing levonorgestrel on hemostasis variables. Am J Obstet Gynecol. 2006;195(1):72-7.

Kolacki C, Rocco V. The combined vaginal contraceptive ring, nuvaring, and cerebral venous sinus thrombosis: a case report and review of the literature. J Emerg Med. 2012;42(4):413-6.

Dunne C, Malyuk D, Firoz T. Cerebral venous sinus thrombosis in a woman using the etonogestrel-ethinyl estradiol vaginal contraceptive ring: a case report. J Obstet Gynecol Can. 2010;32(3):270-3.